Health Care Crisis: Sometimes the Sheer Stupidity of Our Choices is Amazing

AUSTIN, Texas - Bet you if I had a nickel for every time someone has started an article or a speech in past five years by saying, "The nation's health care system is facing a crisis," or, "Our health care system is falling apart," I would be a rich woman today.

I suppose I could come up with some dramatic metaphor for the crumbling, tottering, greed-rotted structure, but hey, why don't you check out your health insurance premiums and see how you're doing? Up by 12 percent, 22 percent, 40 percent?

Larger premiums, higher deductibles, increased payments for prescription drugs? Employer dropping your coverage? Are we having fun yet?

Our money-corrupted political system isn't about to address the systemic problems. I think it's almost self-evident that a single-payer system is the best answer to all the problems, but since we have to deal with political reality, let's shelve that plan for now.

We've got 41.2 million Americans with no health insurance, and that ends up costing us more than it would to pay for their insurance. We pay the world's highest health care taxes. Our government spends $2,604 per capita, the highest of any nation, including those with national health insurance, even though only a quarter of our population is covered by government insurance.

We spend 13 percent of our GDP on health care, the highest in the world. According to the Organization for Economic Cooperation and Development, we spend a total of $4,600 per capita for health care, more than twice the average of other countries. Yet in both life expectancy and infant mortality, we're below the median for developed countries.

If you stand back and look at the fiscal crisis in the states and cities, you will see that almost all of it is driven by health care costs. Naturally, the strapped states and cities can't think of anything to do except start knocking people off Medicaid and the new Children's Health Insurance Program. That just means they wait and get sicker before they finally end up in the emergency room, costing us all more money in the long run.

Sometimes the sheer stupidity of our choices is amazing.

One chunk of this insanely complicated system the politicians are now preparing to tackle is medical malpractice costs. "Med-mal," as it is known in the trade, is the subject of a particularly fruitless argument between Republicans and Democrats over whether the trial lawyers or the insurance companies are to blame for astronomical increases in premiums. This is complicated by the fact that trial lawyers give money to Democrats and insurance companies give money to Republicans.

We've all heard of ridiculous lawsuits by trial lawyers looking for a buck. The insurance companies have well-funded campaigns to publicize idiotic lawsuits - they do not publicize it when the suits get thrown out.

It has never been clear to me why the American Medical Association goes along with blaming trial lawyers rather than insurance companies when their malpractice rates skyrocket. Malpractice is committed only by a tiny percentage of doctors - 5 percent, according to Public Citizen - and the AMA could save itself and everyone else a lot of trouble by getting rid of them.

Of course, trial lawyers do drive at least a part of med-mal costs, but if you examine the competing claims, the insurance industry is the primary villain.

According to The Wall Street Journal, the insurance industry is jacking up prices not just because their investments in the stock market have fallen dramatically, but also because they fouled up their pricing practices in the early '90s. They seriously underpriced med-mal and are now trying to recoup, and for this they blame the lawyers.

California is an interesting case in point. The state passed a tort reform bill, limiting what one can recover in a lawsuit, in 1975 and waited expectantly for insurance premiums to go down. They nearly tripled in the next 12 years, finally leveling off in the early '90s. And, amazingly enough, California just happened to have passed strict insurance regulations in 1988.